Real-life data on safety and efficacy of autologous stem cell transplantation in elderly patients with multiple myeloma

Abstract

Autologous stem cell transplantation (ASCT) is still debatable in treatment of patients over 65 years with multiple myeloma (MM). We performed a retrospective analysis of newly diagnosed MM patients who underwent ASCT between January 2010 and July 2016. A non-transplanted group with similar clinical characteristics, aged 65-70 years old, diagnosed and treated in the same timeline was used for comparison. We analyzed a total of 155 patients, 132 of which underwent ASCT (≤ 65 years, n = 103, median 56 years; > 65 years, n = 29, median 67 years) and 23 non-transplanted (median 68 years). Conditioning consisted of melphalan 200 mg/m² (MEL200) in younger patients and melphalan 140 mg/m² (MEL140) in half of elderly patients. Stratifying by age, there were no statistically significant differences concerning transplant-related myelotoxicity and non-hematopoietic toxicity; however, elderly patients conditioned with MEL200 had higher needs of transfusional support and more days of intravenous antibiotics. Those patients also had higher needs of transfusional support, higher grade of mucositis (p = 0.028), and more days of intravenous antibiotics (p = 0.019) than the elderly transplanted with MEL140. Global transplant-related mortality was 3.8%. Survival was not influenced by age. Non-transplanted elderly patients had comparable disease features, and induction response was similar in both groups (before ASCT in the transplanted cohort). Survival of transplanted elderly patients was superior to non-transplanted (OS, 59 months vs 30 months, p = 0.037; EFS, 45 months vs 27 months, p = 0.014). Selected elderly patients when transplanted have similar disease response and survival as younger patients. A higher dose of melphalan has more toxicity, but it is globally a well-tolerated procedure.

Keywords: Autologous transplantation; Elderly; Multiple myeloma.

Graph 1

Deepening of response after transplant according to age. a Transplanted patients ≤ 65 years old; b transplanted elderly patients

Graph 2

OS according to age, median follow-up 30 months. Median 83 months in patients < 65 years old and 59 months in elderly patients (p = 0.15)

Graph 3

OS according to the dose of melphalan in the elderly group, median follow-up 30 months. Median 59 months in patients conditioned with reduced doses of melphalan vs 62 months in patients conditioned with high doses of melphalan (p = 0.73)

Graph 4

OS of elderly patients according to transplant status, median follow-up 30 months. Transplanted group with a median of 59 months vs 30 months in non-transplanted group (p = 0.037)